Yep. There's a big fiction though that's part of the national identity:
1) Fair. One line.
False: the lawyer does not wait behind the Somali cabdriver. He is neighbors with the doctor.
2) Good enough treatment.
False: aside from trading a few $100 and 1 hour for "free" and 9 hours of your life in a waiting room when you break your leg, there's a shortage of specialists for anything obscure and complicated and even cancer in many provinces.
3) Cost contained.
False: there is a huge problem (insolvency) down the line for basically every province once the class of 1950 turns 80.

And we're not even getting into one's human right to allocate resources towards their health or a doctor to freely hang their shingle and recoup their student debt with this list.

With this painfully obvious example of universal healthcare's fatal shortcomings (pun intended) just to the north, I never got the considerable popularity of obamacare among you janquiz.

With this painfully obvious example of universal healthcare's fatal shortcomings (pun intended) just to the north, I never got the considerable popularity of obamacare among you janquiz.

Most people for Obamacare think there's the US system and then "single payer," and when they think "single payer" they think they're all like Canada's and that Canada's is fantastic and beloved by all Canadians. Surely you've seen the pushback I get here any time I introduce any data to the contrary on this?

Yep. There's a big fiction though that's part of the national identity:
1) Fair. One line.
False: the lawyer does not wait behind the Somali cabdriver. He is neighbors with the doctor.
2) Good enough treatment.
False: aside from trading a few $100 and 1 hour for "free" and 9 hours of your life in a waiting room when you break your leg, there's a shortage of specialists for anything obscure and complicated and even cancer in many provinces.
3) Cost contained.
False: there is a huge problem (insolvency) down the line for basically every province once the class of 1950 turns 80.

And we're not even getting into one's human right to allocate resources towards their health or a doctor to freely hang their shingle and recoup their student debt with this list.

With this painfully obvious example of universal healthcare's fatal shortcomings (pun intended) just to the north, I never got the considerable popularity of obamacare among you janquiz.

I feel like if you guys spend the same amount we do you'd have a far better healthcare system than us. At the very least recoup that 20% in pure administrative costs

We spent 17% of our GDP on health care (50% more than the next highest country, Sweden), and we have the highest GDP in the world. There's so much money in the system, and the system is so complex, that costs just disappear. Nobody has any idea where their money is going, you just have to spend whatever it happens to cost. There's no functioning market at all, and the government and insurers have to just eat costs and raise prices (taxes).

If we knocked our spending down to just 20% more than Sweden, we'd save $700 billion a year.

This gets to a bigger question. We always hear that we can't afford infrastructure, we can't afford to fund our colleges, etc, etc. And you have to wonder where in the hell all the money is going. A huge amount of it is going into healthcare. And we don't even have universal coverage, unlike all these other countries. It's a gigantic problem, and we're just nibbling around the edges of it. At some point we need to reign in costs, either by restricting services and/or by making the market vastly more efficient.

His take is fairly conspiratorial and flat out wrong in a few places with some half truths mixed in (eg Medicare itself doesn't change prices but there's a committee that does which submits their proposal for fair and reasonable prices to Congress and it accounts for geographical and living costs differences. Those prices tend to be higher than other countries but not that much more plus a lot of healthcare in the US especially for poor people tend to be free or income adjusted especially from non profit organizations or charity groups that are subsidized by the US federal and state governments)

Sounds like his overall point is us healthcare is a money black hole that nobody knows about. It's pretty complicated but it's not like we have zero idea

Most other countries have explicit pricing controls which we kinda have but not really. There's a several year old Dartmouth paper that showed the biggest difference between US and the next closest country with similar healthcare model (Germany) was high administrative costs because we have seven different national healthcare systems. Negotiating rates and getting payments alone is a huge portion of that especially since that has to happen separately with every healthcare organization

Obviously a new system would be best one especially with unified and transparent pricing models and one regulating bureaucracy to deal with (like Germany) but considering how gigantic and divided of a beast the us government is it's hard to see anything more different than state exchanges or block grants which are both mediocre to shitty ideas in a vacuum but seems to be the only ones obtainable given current political capital on either side (barring some massive transformation)

Okay, I'll deal with some issues of the US system for ya'll (as I see it, of course.)

1) Medicare. Holy fuck is this a boondoggle and in so many ways. I've talked about the waste here for years and what type of system incents its doctors to just keep treating/billing vs. actually minimizing patient pain and suffering?

2) Med-mal. It's like in no other country. It's part of what drives so much of medicine. Now, I know there's that one study in Texas where utilization didn't drop after some state caps were reformed but do we really think doctors practice differently in Texas? Nope.

3) Duplication. Holy fuck, how many parallel systems does a country need?

4) Publicly traded insurance companies. Do we understand where the intrinsic interests are in publicly traded companies?

Who cares what it costs? There are pricing methods that are based on cost because it is easy to do and in some situations (like contractors competing for DOT jobs get paid a set markup over cost). Look at Dre's Beats... they cost like $14 to make and are sold for $200-600. Other headphones that cost $14 to make sell for $25.

Quote:

Originally Posted by indesertum

His take is fairly conspiratorial and flat out wrong in a few places with some half truths mixed in
Sounds like his overall point is us healthcare is a money black hole that nobody knows about. It's pretty complicated but it's not like we have zero idea

Most other countries have explicit pricing controls which we kinda have but not really. There's a several year old Dartmouth paper that showed the biggest difference between US and the next closest country with similar healthcare model (Germany) was high administrative costs because we have seven different national healthcare systems. Negotiating rates and getting payments alone is a huge portion of that especially since that has to happen separately with every healthcare organization

Agreed. I think there are better ways to do healthcare in this country, no doubt, but it isn't like other countries don't have similar problems - there is fraud, waste, and abuse in every system, and the larger a system gets, the bigger target it becomes.

Okay, I'll deal with some issues of the US system for ya'll (as I see it, of course.)

1) Medicare. Holy fuck is this a boondoggle and in so many ways. I've talked about the waste here for years and what type of system incents its doctors to just keep treating/billing vs. actually minimizing patient pain and suffering?

2) Med-mal. It's like in no other country. It's part of what drives so much of medicine. Now, I know there's that one study in Texas where utilization didn't drop after some state caps were reformed but do we really think doctors practice differently in Texas? Nope.

3) Duplication. Holy fuck, how many parallel systems does a country need?

4) Publicly traded insurance companies. Do we understand where the intrinsic interests are in publicly traded companies?

5) Not letting people die/not placing service restrictions.

AMA has been pushing their tort reform agenda for decades despite evidence to the contrary.

There were experimental provisions for billing for services vs health of patient but I'm not sure if they've been doing well

Quote:

Originally Posted by brokencycle

Who cares what it costs? There are pricing methods that are based on cost because it is easy to do and in some situations (like contractors competing for DOT jobs get paid a set markup over cost). Look at Dre's Beats... they cost like $14 to make and are sold for $200-600. Other headphones that cost $14 to make sell for $25.
Agreed. I think there are better ways to do healthcare in this country, no doubt, but it isn't like other countries don't have similar problems - there is fraud, waste, and abuse in every system, and the larger a system gets, the bigger target it becomes.

The cost vs price idea that makes so much sense in all other aspects of the economy seems to go out the window when people's lives and quality of life is at such a stake

Okay, I'll deal with some issues of the US system for ya'll (as I see it, of course.)

1) Medicare. Holy fuck is this a boondoggle and in so many ways. I've talked about the waste here for years and what type of system incents its doctors to just keep treating/billing vs. actually minimizing patient pain and suffering?

2) Med-mal. It's like in no other country. It's part of what drives so much of medicine. Now, I know there's that one study in Texas where utilization didn't drop after some state caps were reformed but do we really think doctors practice differently in Texas? Nope.

3) Duplication. Holy fuck, how many parallel systems does a country need?

4) Publicly traded insurance companies. Do we understand where the intrinsic interests are in publicly traded companies?

5) Not letting people die/not placing service restrictions.

I know you're a big fan of the Bismark system, and since you started talking about it years ago, I think it makes a lot of sense and think it could be effective here.

If we just apply an 80/20 rule, I think we would focus on doing three things:

1. Eliminate Medicare/Medicaid and replace with public hospitals that provide services free of charge to people. Ideally these would be run at the state level (I think federalism improves processes and gets to best practices faster). Most hospitals/clinics won't be public and free, but this gives an option to all citizens.

2. Decouple insurance and employment. The downside is that it encourages some people to make bad employment decisions and it hides costs from people. Ideally you want costs to be visible to consumers so they have price sensitivity and can make their own trade-offs. For insurance bought individually, you should be able to deduct that rather than having to reach the 2% floor before deducting - that's a huge disadvantage to people who don't get employer based insurance.

3. Allow people to buy any insurance plan they want. Places like MN require insurance cover all kinds of moronic things that drive costs up and provide no benefit to most consumers.

After those three, we can talk about fixing the FDA's approval process that creates such distorted drug and medical device markets.

AMA has been pushing their tort reform agenda for decades despite evidence to the contrary.

There were experimental provisions for billing for services vs health of patient but I'm not sure if they've been doing well
The cost vs price idea that makes so much sense in all other aspects of the economy seems to go out the window when people's lives and quality of life is at such a stake

Why do fundamentals of economics go out the window? I understand the emotional "we can't let people gouge people when their lives are on the line." However, I don't believe we have the right to force anyone to provide us anything. If I develop a wonder drug that saves lives, I should be able to charge whatever I want. I can't force a doctor or nurse or drug company to provide me with goods or services anymore than I can a computer company.

Plus, in liber-topia, the free market will control costs through competition. Some company won't be able to wield political influence to be the only provider of a generic drug.

AMA has been pushing their tort reform agenda for decades despite evidence to the contrary.

Intra-US studies are bogus as doctors are not going to change how they practice at this point. It's going to take a generation or two of doctors to change "standard of care" patterns in the US. I've yet to see a study that compares a basket of diagnosis and their course of treatment across countries. I would love to see a profile case for each diagnosis in a basket and see the entire course of treatment laid out for the US, Canada, UK, France, and Japan.

Quote:

There were experimental provisions for billing for services vs health of patient but I'm not sure if they've been doing well

There's been a number of projects where this was the goal and most (all?) of the participating health systems dropped out as they were seeing revenues fall by really big numbers. This isn't exactly what I was talking about regarding Medicare though. More like things where you've got a patient with advanced dementia (bed bound, complete ADL care, needs to be fed) shows up in the ED with bloody stool and pneumonia. What's the course of care going to be? Colonoscopy immediately and possibly other GI studies, course of ABX for the lungs....fix him/her up for the moment and ship them back to where they came from so they can end up in the ED in another six to ten weeks for something similar or worse (pressure sore.)

If I remember my stimulus rationale, the government spending money is good no matter where it goes. Plus, a lot of healthcare spending ends up paying high salaries from which the government immediately recovers half, give or take.

Why do fundamentals of economics go out the window? I understand the emotional "we can't let people gouge people when their lives are on the line." However, I don't believe we have the right to force anyone to provide us anything. If I develop a wonder drug that saves lives, I should be able to charge whatever I want. I can't force a doctor or nurse or drug company to provide me with goods or services anymore than I can a computer company.

Plus, in liber-topia, the free market will control costs through competition. Some company won't be able to wield political influence to be the only provider of a generic drug.